HİPOTANSİYON TEDAVİSİ : DOĞRU BİLİNEN YANLIŞLAR ve VAZOPRESSÖR AJANLARIN GÜNCELLEMESİ

Yıl 2020, Cilt: 15 Sayı: 1, 52 - 57, 26.03.2020

Sena Ulu Sinan Kazan Özkan Güngör

https://doi.org/10.17517/ksutfd.658161

Öz

Hipotansiyon hızlı bir şekilde düzeltilmediğinde şok tablosu dediğimiz ve doku perfüzyonunda bozulma, multiorgan yetmezliği ve ölüm görülebilir. Vazopresörler, vazokonstrüksiyonla Kan basıncını artıran ajanlardır ve etkilerini adrenerjik sistem reseptörleri üzerinden gösterirler. Bu reseptörlerin yeri ve vazoaktif ajanlara cevapları değişkendir. Önceki yıllarda hipotansiyonda, ilk tercih olarak dopamin kullanılırken, son yıllarda yapılan çalışma ve metaanalizlerde dopaminin yüksek aritmi ve iskemi riski ile immün sistem üzerine olumsuz etkilerinin tespit edilmesiyle, dopaminin güvenliği ile ilgili ciddi endişeler ortaya çıkmıştır. Yine eskiden hipotansiyonda ikinci seçenek olarak düşünülen norepinefrin, son yıllarda birçok çalışmada, şokta sıvı desteği sağlandıktan sonra, ilk tercih edilecek ajanlardan biri olarak önerilmektedir. Son yılarda popülarite kazanmış bir ajan olan Vazopresin de, güçlü vazopressör etkisi ve düşük yan etki profili ile son klavuzlarda, etkin vazopressör ajanlardan biri olarak yerini almıştır. Bu gelişmelerin yanında, yoğun bakım dışındaki anesteziye bağlı hipotansiyon hastalarında da tercih edilmesi gereken ajanlarla ilgili güncel gelişmeler olmuştur.
Bu derlemede, hipotansiyon ve şok tedavisinde, elimizde bulunan güncel veriler ve klavuzlar eşliğinde, vazopresör ajanlar incelenmiş, doğru bilinen yanlışlara da yer verilerek, hipotansiyon tedavisi derlenerek, pratik yaklaşıma değinilmiştir.

Anahtar Kelimeler

Vazopresör, Hipotansiyon, Septik şok

Kaynakça

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